The principal goal of the proposed project is to substantially increase competency in Environmental and Occupational Medicine (EOM) among New York University School of Medicine trainees at multiple levels of training. The long term objectives of this project are to enhance recognition, care and appropriate referral of patients with conditions caused by exposure to Environmental or Occupational (E/O) factors by facilitating integration of principles of EOM into the routine clinical practice of students, as well as residents, fellows and faculty in selected specialties. Integration of EOM into mainstream medical training in NYU programs will be accomplished at several levels of training. A brief screening E/O history questionnaire and a short list of important E/O Sentinel Health Conditions will be used as teaching and clinical tools. Preclinical students will be introduced to E1O history taking and basic concepts of EOM in one first year and three second year courses. EOM concepts and history taking will be reinforced with computer teaching modules and in case conferences in the third year Medicine and Pediatrics clerkships. A series of EOM case conferences will be given to housestaff in Internal Medicine, Primary Care Internal Medicine, Pediatrics, Pulmonary Medicine, Emergency Medicine and Medical Toxicology. The goals of these case conferences are to stimulate interest in EOM and to provide generalizable models for recognizing and diagnosing work- or environmental-relatedness as well as understanding the pathophysiology, comprehensive management, and prevention of E/O diseases. Relevant EOM topics will be presented and discussed in journal clubs in these specialties. Individuals who develop special interest in EOM will be offered a wide variety of elective clinical and research (both laboratory and epidemiology) options to further enhance their interest and expertise in EOM. An ongoing set of evaluation procedures will be developed to evaluate the success of the program in meeting stated objectives, and the results of this evaluation will be used by the candidate and the program advisory committee to improve the curriculum. The proposed program is situated in an academic medical center with a large, active EOM research program. A publicly funded EOM clinic provides services to a large, previously unserved and unstudied population of workers and patients at high risk for diseases of E/O etiology. Dr. Friedman-Jimenez has recruited enthusiastic support for the proposed program from a wide range of relevant departments and divisions. This support, the patient population and the clinical and research links between the medical school and the Department of Environmental Medicine make NYU an exceptionally opportune setting to develop a model curriculum for teaching Environmental and Occupational Medicine.